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All About RBRVS in 90 minutes!

Resource-based relative value scale (RBRVS) is a procedure that helps determine how much money medical providers should be paid. It is partially used by Medicare in the United States. Per RBRVS, a relative value is assigned to procedures performed by a physician or other medical provider, which is adjusted according to geographic region. For instance, a procedure performed in Dallas has less worth than a one performed in Manhattan.

RBRVS determines prices based on three separate factors such as physician work, practice expense and malpractice expense. Though the RBRVS became effective on January, 2014, there is still a lot to learn about this procedure for medical service providers.

In this training session, expert speaker Duane Abbey, Ph.D., will provide you answers to many important questions such as:

What is RBRVS?

Where did it come from?

What is the relationship between RBRVS and MPFS (Medicare Physician Fee Schedule)?

Do both physicians and hospitals need to know about what is in the RBRVS?

Does the RBRVS have anything to do with the Medicare Global Surgical Package (GSP)?

How does the RBRVS accommodate provider-based clinics for hospitals?

Does the RBRVS have anything to do with physician supervision?

How does the MPFS accommodate CPT codes, HCPCS codes and the various modifiers?

Which healthcare providers and suppliers are paid using RBRVS?

Are there special provisions in RBRVS for non-physician practitioners?

Areas covered in the session:

Overview of RBRVS

Types of Health Care Payment Systems

Fee Schedule Payment Systems

Historical Development and Use of RBRVS

Types of Providers Covered by RBRVS

MPFS – Medicare Physician Fee Schedule

Locating and Downloading the RBRVS

Elements Within the RBRVS

RVUs

Facility

Non-Facility

Special Indicators for Adjudication

Post-Operative Periods

Pre-Operative and Post-Operative Payment Splits

Diagnostic Supervision Levels

Additional Information

Relative Values

Three Components for RVUs

Basis for Development of RVUs

Facility versus Non-Facility Practice Expense RVUs

Using RBRVS To Establish Charges

Developing a Professional Fee Schedule

Developing Chargemaster Facility charges

Global Surgical Package

Pre-Operative and Post-Operative Periods

Pre-Operative, Intra-Operative and Post-Operative Payments

Use of the “-54”, “-55” and “-56 Modifiers

Normal Complications and Return to Operating Room Concepts

Provider-Based Clinics and RBRVS

Freestanding versus Provider-Based

Place of Service and Site of Service Differential

Economic Advantages for Provider-Based

Special Situations

Hospital Payments Under RBRVS

Physical Therapy and Occupational Therapy

Critical Access Hospitals

Related Fee Schedule Concepts

Special Issues

Special Organizations

Physician Supervision

3-Day Payment Window

Sustainable Growth Rate (SGR)

Sources for Information on RBRVS

Session objectives

To discuss the Resource Based Relative Value Scale (RBRVS) which provides the basis for the Medicare Physician Fee Schedule (MPFS)

To appreciate RBRVS as a fee schedule health care payment system

To appreciate how RBRVS is structured and how payments are calculated

To understand how hospitals become involved in and can utilize the Medicare physician fee schedule (MPFS)

Duane C. Abbey, Ph.D. is a management consultant and president of Abbey & Abbey, Consultants, Inc., which specializes in healthcare consulting and related areas. Duane earned his graduate degrees at the University of Notre Dame and Iowa State University and has more than 20 years of experience as a consultant. He performs various types of financial analysis involving business structuring, organizational development, enrollment and other financially related concerns of organizations....
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